Healthcare Provider Details

I. General information

NPI: 1821640624
Provider Name (Legal Business Name): EMMA E ATWELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S STE 500
JACKSONVILLE FL
32216-7405
US

IV. Provider business mailing address

3627 UNIVERSITY BLVD S STE 500
JACKSONVILLE FL
32216-7405
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-5678
  • Fax: 904-399-8488
Mailing address:
  • Phone: 904-399-5678
  • Fax: 904-399-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: